Basic Information
| Provider Information | |||||||||
| NPI: | 1003381641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLAZAKIS | ||||||||
| FirstName: | ALAYNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2824 ONTARIO AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212341111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109358984 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5601 LOCH RAVEN BLVD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212392945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434444275 | ||||||||
| FaxNumber: | 4434444276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R191300 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.